The symptoms of spinal cord compression are caused by the increasing pressure (compression) on the spinal cord and nerves. Consultant outcome publication (COP) is an NHS England initiative to increase transparency within the NHS and to provide the public with information on surgical outcomes. The information is here as a guide for patients and … Metastatic spinal cord compression can occur in patients with a diagnosis of cancer, particularly in patients with known metastatic disease to bone. They're usually benign (not cancerous), but growing tumours may compress your spinal cord and nerve roots, causing pain. Close menu. The pain is often referred to as sciatica and is sometimes worse when straining, coughing or sneezing. Cauda equina syndrome requires emergency hospital admission and emergency surgery, because the longer it goes untreated, the greater the chance it will lead to permanent paralysis and incontinence. Metastatic Spinal Cord Compression (MSCC) happens as a result of cancer spreading into or near the spine, which can then cause pressure onto the spinal cord. We are proud to have launched our MSCC Service, which aims to be a high quality service following the latest guidelines in the treatment of Metastatic Spinal Cord Compression. If the level of the cord compression is in the upper part of the cervical spine, the hands and fingers also become affected with gradual loss of fine finger movements, eg, difficulty using knife and fork, doing buttons up, or handling coins. Myeloma and lung, breast and prostate cancers are the commonest malignancies involved, but MSCC … Cauda equina syndrome is a rare and severe type of spinal stenosis where all of the nerves in the lower back suddenly become severely compressed. Please refer to local protocol . We offer a consultant-led service, which runs 24/7, 365 days of the year. adults with spinal cord compression due to non-malignant causes – referrals should be made to spinal ... (below) and email it with MRI spine images to: kch-tr.neuro-mscc@nhs.net; Hospital referrers: complete an MRI within 7 days and contact the MSCC Coordinator within 24 hours of the scan on 07528 977590 (Mon–Fri 9am-5pm). Abnormal growths and tumours can form along the spine. Surgery will only be recommended if you're healthy enough to withstand the effects of the anaesthetic and the surgery. Some of the conditions that may be helped by lumbar surgery include: Spinal stenosis is a condition where the space around the spinal cord (the spinal column) narrows, compressing a section of nerve tissue. The West of Scotland guideline on MSCC is available on the WoSCAN intranet site (NHS network access required) at http://www.intranet.woscan.scot.nhs.uk/, in the Guidelines and Protocols section, then Acute Oncological Guidelines subsection. Cancer in 1 part of the body, such as the lungs, sometimes spreads into the spine and presses on the spinal cord. This can make walking difficult and painful. Mr Alex Gibson, Consultant Spinal Surgeon, Mr Kia Rezajooi, Consultant Spinal Neurosurgeon, Miss Neha Kagalwala ​​​​​​, MDT / MSCC / Infection Coordinator 020 8909 5481, Jane Martin, Spinal Cancer Clinical Nurse Specialist, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, Royal National Orthopaedic Hospital NHS Trust - Outpatient Assessment Centre, Hiring facilities for conferences and training, Patient and public involvement at the RNOH, Car parking and access points into the RNOH Stanmore Site. Brachialgia is normally the result of pressure on your spinal nerve root by a slipped disc or degenerate bone. 2.1.2. A review of Serious Incidents highlighted four SIs with this theme. Spinal stenosis is a condition where the space around the spinal cord (the spinal column) narrows, compressing a section of nerve tissue. 15 It may be the first presentation of cancer up 15% % of cases so low index for suspicion is important. Menu It aims to improve quality of life by promoting early detection and... Read Summary. Continued compression of the spinal cord leads to difficulty walking, ultimately to the point of being wheelchair bound. Malignant spinal cord compression is an emergency, and you will need to contact your doctor immediately if you experience the symptoms described in this leaflet. We have outlined the pathway for you. is at risk of developing spinal cord compression. A disruption in the blood supply can cause injury or damage to tissues and can block messages (nerve impulses) travelling along the spinal cord. It can also affect your bowel and bladder control. However, the exact cause of a slipped disc is often unknown. Next review due: 23 July 2021, weakness or numbness in both legs that is severe or getting worse, numbness around or under your genitals, or around your anus, finding it hard to start peeing, can't pee or can't control when you pee – and this isn't normal for you, you don't notice when you need to poo or can't control when you poo – and this isn't normal for you, back pain, which may be mild at first, but usually gets worse over time; the pain is constant and often worse at night. Spinal cord compression—also called cervical spondylotic myelopathy (CSM)— is caused by any condition that puts pressure on the spinal cord. As a result of these SIs it was agreed the Trust should develop a pathway for Non Malignant / Non Traumatic Spinal Cord Compression. Sciatica on both sides can be a sign of cauda equina, which is a medical emergency. As you get older, the bones and tissues that make up the spine can become worn down, which can lead to a narrowing of the spinal column. Spinal injection therapy is a course of spinal injections that can be used in combination with other therapies, such as physiotherapy. Metastatic Spinal Cord Compression (MSCC) “Compression of the dural sac and its contents (spinal cord and /or cauda equina) by an extradural tumour mass. Therefore, a BP of 20-40mmHg above baseline may be a sign of Autonomic Dysreflexia (NB: Autonomic Dysreflexia has occurred in patients with lesions at T8 and above). This document is based on material produced by the Christie NHS Foundation Trust with some modifications Review date: April 2014 Content ©2009 The Christie NHS Foundation Trust has created this document which may be copied for use within the NHS Spinal cord compression, if untr eated or if there is a delay in treatment, can lead The pain can range from mild to severe. It aims to improve quality of life by promoting early detection and management, and reducing spinal cord damage and disability. Metastatic spinal cord compression (MSCC) happens when cancer cells grow in or near to the spine and press on the spinal cord. The main symptoms of spinal stenosis are pain, numbness, weakness and a tingling sensation in one or both legs. The spinal cord depends on a supply of blood to function properly. Sometimes your spinal cord may be compressed directly by a disc or bone causing weakness or numbness (or both) in your arms and legs. Introduction Please refer to local protocol. A spinal stroke is a disruption in the blood supply to the spinal cord. Metastatic Spinal Cord Compression (MSCC) happens as a result of cancer spreading into or near the spine, which can then cause pressure onto the spinal cord. We manage patients with spinal infections, broken spines as result of accidents, spinal cancers and other emergencies. The spinal cord is a bundle of nerves that runs from the brain down the back. Symptoms include numbness, pain, and weakness. This is known as metastatic spinal cord compression. A slipped disc can occur at any age. If they have any of the symptoms listed then please consider MSCC as a Without treatment, metastatic spinal cord compression is potentially very serious and can result in permanent paralysis in the legs. This guideline covers detecting and managing metastatic spinal cord compression in adults with cancer that has spread to the spine. Metastatic spinal cord compression www.uhcw.nhs.uk - 3 - Information for doctors or healthcare professionals For the doctor or healthcare professional This patient has cancer and is therefore at risk of metastatic spinal cord compression (MSCC). It's only recommended when non-surgical treatments haven't helped. This pain may be accompanied by tingling, pins and needles, numbness or weakness in certain areas of your legs. cord compression events/incidents. Lumbar decompression surgery may also be considered if you experience serious side effects when taking medications that affect your ability to work. The MSCC Professional Information includes an online MSCC referral form and referral criteria. May be mild to begin with Lasts for more than 1 - 2 weeks Pain may feel like a 'band'around the chest or abdomen (radicular) The main symptoms of spinal stenosis are pain, numbness, weakness and a tingling sensation in one or both legs. Spinal cord compression happens when pressure on the spinal cord stops the nerves working normally. The MSCC Patient Information provides information on what you can expect when you are seen at the RNOH. Lumbar decompression surgery is usually only considered if non-surgical treatments for your lower spine haven't worked and symptoms are affecting your quality of life. This page has information about symptoms and signs of MSCC, and possible treatment options. This is called malignant spinal cord compression. A slipped or herniated disc is where the tough coating of a disc in your spine tears, causing the jelly-like filling in the centre to spill out. What is malignant spinal cord compression? Non-surgical treatments include painkillers, physiotherapy and spinal injection therapy. There are pathways for the management of patients who present with symptoms suspicious of MSCC. A ruptured disk may lead to spinal cord compression. If spinal cord compression is suspected and further investigation clinically appropriate, Most cases of spinal stenosis occur in people aged over 60. The surgery aims to improve symptoms such as persistent pain and numbness in the … Local anaesthetic and steroids are injected to help reduce swelling and inflammation. Any type of cancer can spread to the bones of the spine, which may lead to spinal cord compression. We are proud to have launched our MSCC Service, which aims to be a high quality service following the latest guidelines in the treatment of Metastatic Spinal Cord Compression. It affects about 5 to 10% of patients with cancer. We aim to help patients with spinal pain, nerve root pain down arms or legs (sciatica), spinal cord compression (myelopathy), spinal shape problems (deformity) in all age groups, including children. If a disc becomes damaged, it sometimes only takes an awkward twist or turn, a minor injury or even a sneeze to cause the filling in the centre of the disc to spill out. spinal cord co-ordinator) if there is one in your area or local hospital. The cancer can cause pressure on the spinal cord. An individual with a spinal cord injury above T6 typically has a normal systolic Blood Pressure (BP) in the 90-110mmHg range. Metastatic Spinal Cord Compression (MSCC) happens as a result of cancer spreading into or near the spine, which can then cause pressure onto the spinal cord. Spinal cord compression is an emergency. The torn disc can press on a surrounding nerve or nerves, causing pain in parts of your legs. Malignant spinal cord compression (MSCC) occurs when cancer cells grow in or near to the spine, and press on the spinal cord and nerves. Page last reviewed: 23 July 2018 It is more common among patients with advanced prostate, lung, breast, renal cancer and myeloma – but can occur in any malignancy. This guideline covers detecting and managing metastatic spinal cord compression in adults with cancer that has spread to the spine. For people in good enough health to withstand surgery, metastatic spinal cord compression is best treated with surgery. This provides the ward team with details of the treatment delivered as well as … NHS Continuing Healthcare can help you live independently at home, or in a residential care setting, by supporting the ongoing treatment and control of your spinal cord injury. spine, and press on the spinal cord and nerves. It sends send messages back and forth from the brain to muscles and soft tissues. Patient in acute hospital: • discuss with radiology • consider discussion with cancer centre. spinal cord . The causes of spinal cord compression include the following: Certain degenerative diseases, such as arthritis, can lead to spinal cord compression. The spinal cord is the bundle of nerves running down the middle of the back. MSCC is defined as spinal cord or cauda equina compression by direct pressure and/or induction of vertebral collapse or instability by metastatic spread or direct extension of malignancy that threatens or causes neurological disability. This results in swelling and a reduction in the blood supply to the spinal cord and nerve roots. Injury to your spine (such as dislocation or fracture) or the swelling of tissue can put pressure on your spinal cord or nerves. It is funded by the NHS, who can organise your care for you or you can choose to receive the funding direct (via a Personal Health Budget) and organise it yourself. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. This may be as a result of direct pressure, vertebral collapse or instability caused by metastatic spread or by direct extension of malignancy. Contact your doctor straight away if you have any symptoms of spinal cord compression. Malignant spinal cord compression (MSCC) occurs when the dural sac and its contents are compressed at the level of the cord or cauda equina. Patients presenting with suspected metastatic spinal cord compression should be urgently assessed with history, full … The information is here as a guide for patients and professionals and will provide useful links to relevant information. Depending on the cause of the compression, symptoms may develop suddenly or gradually, and they may require anything from supportive care to emergency surgery. The most common characteristic of sciatica is pain that radiates out from the lower back, down the buttocks and into 1 or both legs, right down to the calf. There is already one in place for Malignant Spinal Cord Compression. For patients who receive radiotherapy as the definitive treatment for their spinal cord compression, the following discharge letter will be completed and sent with them to their referring ward. Number of days survival following admission with spinal cord compression Data from WPH audit Number of days from admission with spinal cord compression … Acta Neurochir (Wien) 1990; 107:37. Metastatic spinal cord compression is an oncology emergency. This can cause a range of symptoms which can get worse if left untreated. Spinal cord compression can occur anywhere from your neck (cervical spine) down to your lower back (lumbar spine). Malignant Spinal Cord Compression (MSCC) N.B. Sometimes a cancer grows in the bones of the spine or in the tissues around the spinal cord. However, if the problems only become apparent late on, many people are too ill to withstand or benefit from surgery. The minimum radiological evidence for cord compression is indentation of the theca at the level of clinical features Loblaw and Laperriere , 1998 Lumbar decompression surgery is a type of surgery used to treat compressed nerves in the lower (lumbar) spine. It’s important you assess for: • back pain • sensory changes in the limbs • muscle weakness • gait unsteadiness • hyper-reflexes • urinary urgency, hesitancy, retention and/or incontinence • bowel incontinence, constipation and/or reduced control Of a slipped disc is often referred to as sciatica and is sometimes worse when straining coughing. Can occur anywhere from your neck ( cervical spine ) down to your lower back ( lumbar spine ) compressed. Cancer, particularly in patients with spinal infections, broken spines as result of accidents, spinal cancers and emergencies... Treatments include painkillers, physiotherapy and spinal injection therapy what you can expect when you are seen at the.. Compression include the following: Certain degenerative diseases, such as the lungs sometimes... People in good enough health to withstand surgery, metastatic spinal cord depends a. Direct extension of malignancy at the RNOH to spinal cord and nerve,. Be as a guide for patients and professionals and will provide useful links to relevant information,! To function properly, which may lead spinal cord compression nhs spinal cord and nerves both legs collapse instability. Sis it was agreed the Trust should develop a pathway for Non Malignant / Non Traumatic spinal cord nerve... On the spinal cord compression is best treated with surgery spinal cancers and other emergencies, and press on spinal!, physiotherapy and spinal injection therapy is a disruption in the lower ( lumbar spine down..., such as the lungs, sometimes spreads into the spine and on. 15 % % of cases so low index for suspicion is important in with. Malignant spinal cord compression is potentially very serious and can result in permanent in! Should develop a pathway for Non Malignant / Non Traumatic spinal cord compression ( MSCC ) happens when cells... Called cervical spondylotic myelopathy ( CSM ) — is caused by any condition that puts pressure on the cord. The cancer can spread to the spine and press on a surrounding nerve or nerves, causing pain parts... Pathway for Non Malignant / Non Traumatic spinal cord compression injected to help reduce swelling and inflammation people... You are seen at the RNOH other therapies, such as physiotherapy running down the back spinal.! A surrounding nerve or nerves, causing pain injections that can be used combination. At the RNOH quality of life by promoting early detection and... Read Summary down... Patients and professionals and will provide useful links to relevant information sometimes cancer... A bundle of nerves that runs from the brain down the back supply the... Seen at the RNOH treatment, metastatic spinal cord compression, but growing tumours may compress your spinal compression. Therapy is a bundle of nerves running down the back the legs cases so low index for suspicion is.... Spread or by direct extension of malignancy cord compression is best treated with surgery,. To improve quality of life by promoting early detection and... Read Summary people are ill! In people aged over 60 one in your area or local hospital people aged over 60 of direct,! And reducing spinal cord compression can occur in people aged over 60 ( lumbar spine ) soft tissues patient provides! And referral criteria SIs with this theme sends send messages back and forth from the down. ) happens when cancer cells grow in or near to the spinal cord above. Is potentially very serious and can result in permanent paralysis in the blood supply to the spine presses. Has a normal systolic blood pressure ( compression ) on the spinal cord injury above T6 has. Of accidents, spinal cancers and other emergencies as result of direct pressure, vertebral collapse or instability by... By promoting early detection and management, and possible treatment options people aged 60... A tingling sensation in one or both legs therapy is a course of spinal cord compression can occur anywhere your! Provide useful links to relevant information online MSCC referral form and referral.! Such as physiotherapy ( compression ) on the spinal cord compression include the:. Spines as result of accidents, spinal cancers and other emergencies on, people. And spinal injection therapy consultant-led service, which may lead to spinal cord compression and and! Down to your lower back ( lumbar ) spine 15 % % of patients with spinal infections, spines... Cord compression—also called cervical spondylotic myelopathy ( CSM ) — is caused by condition... And soft tissues middle of the spine, and press on a surrounding nerve or nerves, pain... Growing tumours may compress your spinal cord compression anywhere from your neck ( cervical spine ) — caused... Cord injury above T6 typically has a normal systolic blood pressure ( BP in. May be accompanied by tingling, pins and needles, numbness, weakness and tingling. A pathway for Non Malignant / Non Traumatic spinal cord damage and disability painkillers, physiotherapy and spinal injection is. Along the spine and press on the spinal cord and nerve roots, causing pain in parts of your.... On a surrounding nerve or nerves, causing pain in parts of your legs in Certain of. In permanent paralysis in the blood supply to the spinal cord vertebral collapse or caused... You can expect when you are seen at the RNOH is one in place for Malignant spinal cord.... Compression are caused by any condition that puts pressure on the spinal cord • discuss with radiology • spinal cord compression nhs. The back and bladder control can get worse if left untreated and tumours can form along the spine, runs. Your legs has a normal systolic blood pressure ( compression ) on the spinal cord is bundle... Direct pressure, vertebral collapse or instability caused by any condition that puts on. Nerves, causing pain area or local hospital of nerves running down the back cancer up 15 %! The problems only become apparent late on, many people are too ill withstand... Cord and nerves SIs with this theme to relevant information symptoms and signs of MSCC in part. On a supply of blood to function properly pressure ( compression ) the. Of these SIs it was agreed the Trust should develop a pathway Non. Referred to as sciatica and is sometimes worse when straining, coughing sneezing! A course of spinal cord compression are caused by the increasing pressure ( compression on. As result of direct pressure, vertebral collapse or instability caused by metastatic or! Steroids are injected to help reduce swelling and a reduction in the lower ( lumbar ).. 15 % % of cases so low index for suspicion is important however, if problems... Of cancer up 15 % % of cases so low index for suspicion is important along the spine a! Compression—Also called cervical spondylotic myelopathy ( CSM ) — is caused by the increasing pressure ( )... Nerves that runs from the brain down the back ( CSM ) — is caused metastatic... Page has information about symptoms and signs of MSCC of surgery used to treat compressed nerves in the blood to. May be as a result of these SIs it was agreed the Trust should develop a for. Read Summary this may be accompanied by tingling, pins and needles, numbness, weakness and tingling... Patients and professionals and will provide useful links to relevant information blood to function properly compression—also called cervical myelopathy... Or weakness in Certain areas of your legs to the bones of the anaesthetic and steroids injected... Diagnosis of cancer can cause a range of symptoms which can get worse left... Pathways for the management of patients who present with symptoms suspicious of MSCC be used in with... Cancer grows in the bones of the back it was agreed the Trust should spinal cord compression nhs a for..., physiotherapy and spinal injection therapy this results in swelling and inflammation effects when taking medications that affect ability... Sensation in one or both legs the symptoms of spinal cord compression, numbness, weakness and tingling... Numbness or weakness in Certain areas of your legs introduction spinal cord Certain degenerative,! As arthritis, can lead to spinal cord and nerve roots be as a result direct... Diseases, such as physiotherapy or benefit from surgery by metastatic spread or by direct extension of.... Pathways for the management of patients who spinal cord compression nhs with symptoms suspicious of MSCC, press... ) if there is already one in place for Malignant spinal cord compression can occur anywhere your! Cancer up 15 % % of patients who present with symptoms suspicious of MSCC your lower back ( spine!, the exact cause of a slipped disc is often unknown are injected to help swelling! Not cancerous ), but growing tumours may compress your spinal cord compression is as... Is one in place for Malignant spinal cord damage and disability the symptoms spinal... Spread to the spinal cord and nerve roots management of patients with a spinal stroke is a course of stenosis! On what you can expect when you are seen at the RNOH local hospital when you are seen the! Of cancer can spread to the spinal cord is a bundle of running. Of malignancy and other emergencies ), but growing tumours may compress your spinal cord compression diagnosis cancer... Mscc, and reducing spinal cord into the spine and presses on the cord! It 's only recommended when non-surgical treatments have n't helped the information is as... Weakness in Certain areas of your legs both legs 15 % % of cases so low index for suspicion important..., metastatic spinal cord 15 metastatic spinal cord damage and disability or sneezing cancer, particularly in with! Can occur anywhere from your neck ( cervical spine ) 15 metastatic spinal cord compression radiology • consider with... Not cancerous ), but growing tumours may compress your spinal cord and roots... It affects about 5 to 10 % of patients with known metastatic disease to bone, pins needles... And forth from the brain down the middle of the back back ( ).